Rezai Mohammad Sadegh, Ghasempouri Hiva, Asqary Marzidareh Ozra, Yazdani Cherati Jamshid, Rahmatpour Rokni Ghasem
Pediatric Infectious Diseases Superspecialist, Infectious Diseases Research Center with focus on Nosocomial Infections, Mazandaran University of Medical Sciences, Sari, Iran.
General physician, Mazandaran University of Medical Sciences, Sari, Iran.
Iran J Med Sci. 2019 Jan;44(1):10-17.
Common resistant-to-therapy warts pose a challenge to both clinicians and patients. Among many destructive and immunotherapeutic options, no single, fully effective treatment has been suggested yet. Many investigations, including those using intralesional antigen administrations, have demonstrated that cellular immunity plays a major role in the clearance of human papilloma virus (HPV) infection. The aim of the present study was to evaluate the effects of the intralesional injection of the measles-mumps-rubella (MMR) vaccine into resistant-to- treatment palmoplantar warts and its complications.
In this single-blind, randomized, controlled clinical trial, 60 cases with resistant-to-therapy palmoplantar warts referring to the Dermatology Clinic of Bou-Ali Sina Hospital of Sari between June 2015 and 2016 were randomly assigned to 2 equal groups: the MMR Group received intralesional MMR and the Placebo Group was given saline injection. The injections were administered at 2-week intervals until complete clearance was achieved or for a maximum of 5 injections (<5 injections at 2-week intervals). The study protocol was registered in the Iranian Registry of Randomised Clinical Trials (ID: IRCT2016101027636N3), and the statistical analyses were performed using SPSS, version 17.0. The χ2 test and the F-test were used as appropriate, and a P value less than 0.05 was considered statistically significant.
Complete clearance was observed in 65.2% (14⁄23) of the patients presenting with resistant-to-therapy palmoplantar warts in the MMR Group and 23.85% (5/21) in the Placebo Group (P=0.021). Recurrence was not observed in any of the completely cured patients at 6 months' follow-up.
Intralesional immunotherapy with the MMR vaccine may result in a desirable therapeutic response and can be used as an effective and safe treatment option for palmoplantar warts, particularly persistent ones. IRCT2016101027636N3.
常见的治疗抵抗性疣对临床医生和患者都构成了挑战。在众多破坏性和免疫治疗方法中，尚未有单一的、完全有效的治疗方案被提出。许多研究，包括那些采用病灶内注射抗原的研究，都表明细胞免疫在清除人乳头瘤病毒（HPV）感染中起主要作用。本研究的目的是评估向治疗抵抗性掌跖疣病灶内注射麻疹-腮腺炎-风疹（MMR）疫苗的效果及其并发症。
在这项单盲、随机、对照临床试验中，2015年6月至2016年期间转诊至萨里布阿里·西纳医院皮肤科诊所的60例治疗抵抗性掌跖疣患者被随机分为两组，每组人数相等：MMR组接受病灶内注射MMR，安慰剂组注射生理盐水。注射每隔2周进行一次，直到完全清除或最多注射5次（每隔2周注射<5次）。该研究方案已在伊朗随机临床试验注册中心注册（编号：IRCT2016101027636N3），并使用SPSS 17.0版进行统计分析。根据情况使用χ2检验和F检验，P值小于0.05被认为具有统计学意义。
MMR组中65.2%（14/23）的治疗抵抗性掌跖疣患者实现了完全清除，安慰剂组为23.85%（5/21）（P = 0.021）。在6个月的随访中，所有完全治愈的患者均未出现复发。
MMR疫苗病灶内免疫疗法可能产生理想的治疗反应，可作为掌跖疣，特别是持续性掌跖疣的有效且安全的治疗选择。IRCT2016101027636N3。
